Literature Collection

Drawing upon a longitudinal survey of clinicians who treat patients with opioid use disorder (OUD), we report changes over time in telemedicine use, clinicians' attitudes, and digital equity strategies. Clinicians reported less use of telemedicine (both video and audio-only) in 2022 than in 2020. In March 2022, 77.0 percent of clinician respondents reported implementing digital equity strategies to help patients overcome barriers to video visits.

PURPOSE: Strengthening primary care's integration function is a systematic approach to promote integrated care. Understanding the factors influencing the process of integrating care for every patient is crucial for effective intervention planning. The objective of this study was to generate an analytic framework and evidence map of the barriers and facilitators perceived by family physicians (FPs) in clinical integration, a process to coordinate health care services across time, place, discipline, diseases, and patient demographics. METHODS: Using the Joanna Briggs Institute umbrella review methodology, we searched the MEDLINE, Embase, and CINAHL databases, identifying 90 reviews (2010-2022) on primary care FPs and clinical integration. We adopted a best-fit framework approach to group the factors into a customized clinical integration framework, reflecting how a health care system functions. Two evidence maps were created to visualize the reviews' distribution. We validated the framework with another 21 reviews (2022-2024). RESULTS: The analytic framework consisted of 9 themes and 21 subthemes based on 2,891 factors derived from external and internal sources within primary care practices. Several subthemes were common across themes related to individuals (FPs, physicians other than family physicians and allied health providers, patients) and operating units (systems, organizations, practices), highlighting shared elements. The professional theme was the most significant, appearing in 86% of the reviews and including subthemes related to diseases, clinical guidelines, and teamwork. In contrast, themes related to systems, organizations, and practices were reported less frequently (48%, 22%, and 23%). CONCLUSION: The complex interactions among factors, subthemes, and themes elucidate challenges in finding a universal strategy or implementing initiatives. The generated evidence maps indicated knowledge gaps to guide future research work.

Executive summary -- Background and overview -- What is the epidemiology and burden of disease associated with mental health and substance use issues? -- To what extent have people interacted with primary care providers about their mental health or substance use issues, and how have primary care providers responded? -- What are the potential roles of primary care teams with respect to mental health and substance use issues? -- What is the evidence for the efficacy of early identification and early intervention in primary care settings for mental health and substance use issues? -- What is the evidence for the effectiveness and cost effectiveness of primary care-level collaboration in addressing mental health and substance use issues? -- What are the potential models for organizing primary care team collaboration directed at addressing mental health and substance use issues?

BACKGROUND: Systems fragmentation is a major challenge for an efficient organization, integration being a potential solution also proposed in health care field, including pharmacy as a player. However, the use of different terms and definitions in the literature hinders the comparison of different integration initiatives. OBJECTIVE: To identify and map the terms used in scientific literature regarding integration in health care and to characterize each emerging topic. METHODS: A lexicographic analysis of the integration of healthcare systems literature indexed in PubMed was conducted. Ten different systematic searches, four using only Medical Subject Headings (MeSH) and six using text words, were conducted in March 2023. Journal scattering was analyzed following Bradford's distribution using the Leimkuhler model. An overall text corpus was created with titles and abstracts of all the records retrieved. The corpus was lemmatized, and the most used bigrams were tokenized as single strings. To perform a topic modeling, the lemmatized corpus text was analyzed using IRaMuTeQ, producing descending hierarchic classification and a correspondence analysis. The 50 words with higher chi-square statistics in each class were considered as representative of the class. RESULTS: A total of 42,479 articles published from 1943 to 2023 in 4469 different journals were retrieved. The MeSH "Delivery of Health Care, Integrated", created in the 1996 MeSH update, was the most productive retrieving 33.7 % of the total articles but also retrieving 22.6 % of articles not retrieved in any other search. The text word "Integration" appeared in 15,357 (36.2 %) records. The lexicographic analysis resulted in 7 classes, named as: Evidence and implementation, Quantitative research, Professional education, Qualitative research, Governance and leadership, Clinical research, and Financial resources. Association between the classes and the searches or the text-words used ranged from moderate to weak demonstrating the lack of a standard pattern of use of terms in literature regarding healthcare integration. CONCLUSIONS: The term "integration" and the MeSH "Delivery of Health Care, Integrated" are the most used to represent the concept of integration in healthcare and should be the preferred terms in the literature.

Navigating mental health support is a top priority in Canada. Journey maps can provide lived experience insights for mental health innovation. A PubMed literature search yielded nine frameworks, conceptualizing the navigation process as: recognition, sensemaking, perceived need, seeking, self-care, healthcare, and recovery. This process forms the basis of a journey map for mental health navigation.

BACKGROUND: Healthcare system sustainability is challenged by several critical issues; one of the most pressing is the ageing population. Traditional, episodic care delivery models are not designed for older people who are medically complex and frail. These individuals would benefit from health and social care that is more comprehensive, coordinated, person-centred and accessible in the communities in which they live. Delivering this is a challenging endeavour. Community-based health and social care professionals are siloed, dispersed across various locations and sectors, each with their own mental models, electronic health information systems, and means of communication. To move away from fragmented care delivery models and towards a more integrated approach to care, an analysis of the process of community-based comprehensive geriatric assessment was conducted in an urban location in Atlantic Canada. The purpose of the study was to identify where in the community-based comprehensive geriatric assessment process challenges and opportunities existed for moving towards a more integrated model of care delivery. METHOD: The functional resonance analysis method (FRAM) and dynamic FRAM (DynaFRAM) modelling were used to model the community-based health and social care system and create a hypothetical patient journey scenario. Data collected to inform modelling consisted of document review, focus groups, and semi-structured interviews with health and social care professionals providing care and service to older people in the community setting. FINDINGS: Challenges and opportunities for implementing integrated care in the local context were identified. Findings from the FRAM and DynaFRAM analysis informed the co-design of multi-level process improvement recommendations that aim to move the local community-based comprehensive geriatric assessment process towards a more integrated model of care. CONCLUSIONS: A transformative redesign of community-based health and social care in the local context is necessary but cannot be accomplished without an understanding of how health and social care professionals conduct their work and how older people may receive care under the dynamic conditions. The FRAM and DynaFRAM modelling provided an enhanced understanding of system operations and functionality and demonstrated a critical step that should not be overlooked for decision-makers in their efforts to implement a more integrated model of care.

Crack cocaine users frequently report difficulties regarding having healthy and rewarding relationships. Factors other than the use of crack cocaine itself may be at play when it comes to being able to develop healthier connections with partners, adult relatives and close friends. To verify which factors, including demographics, substance abuse related factors and psychiatric comorbidities could be markers for a higher severity of problems in interpersonal relationships of crack cocaine users seeking for treatment. This was a cross-sectional study, conducted between April 2011 and November 2012. Participants were 407 crack cocaine users seeking treatment in specialized public facilities of six Brazilian capitals. The relationship of severity of problems in the family/social area and the prevalence of psychiatric disorders, exposure to stressful events, substance use related factors and practice of illicit activities were explored through multivariate analyses. Number of days using crack cocaine in the last 30 days, age of first time using alcohol and feeling its effects, a diagnosis of alcohol abuse, posttraumatic stress disorder, antisocial personality disorder and attention-deficit/hyperactivity disorder were significantly associated with a higher severity of problems in interpersonal relationships with partners, adult relatives and friends. Problems in interpersonal relationships are strongly related to specific psychiatric comorbidities and the frequency of crack cocaine use. Factors identified by this study can make the paths to recovery more challenging. These results support psychosocial interventions that focus in the improvement of interpersonal relationships of crack cocaine users.